1073928875 NPI number — LUTHERAN FAMILY SERVICES OF VIRGINIA

Table of content: (NPI 1073928875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073928875 NPI number — LUTHERAN FAMILY SERVICES OF VIRGINIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUTHERAN FAMILY SERVICES OF VIRGINIA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073928875
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2609 MCVITTY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24018-3513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-774-7100
Provider Business Mailing Address Fax Number:
540-774-1084

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4651 N FREDERICK PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINCHESTER
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22603-2838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-450-2782
Provider Business Practice Location Address Fax Number:
540-450-2783
Provider Enumeration Date:
07/01/2014

Additional Information

Authorized Official

Authorized Official Last Name:
KING
Authorized Official First Name:
FREIDA
Authorized Official Middle Name:
MAE
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
540-562-8473

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  272-02-029 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com